TWO-YEAR DIRECT AND INDIRECT COSTS FOR PATIENTS WITH INFLAMMATORY RHEUMATIC JOINT DISEASES: DATA FROM REAL LIFE FOLLOW-UP OF PATIENTS IN THE NOR-DMARD REGISTRY

Monday, October 24, 2011
Grand Ballroom AB (Hyatt Regency Chicago)
Poster Board # 12
(ESP) Applied Health Economics, Services, and Policy Research

Candidate for the Lee B. Lusted Student Prize Competition


Maria K. Kvamme, MSc1, Elisabeth Lie, MD, Research, fellow2, Tore K. Kvien, MD, PhD, Professor2 and Ivar Sønbø Kristiansen, MD, PhD, MPH1, (1)University of Oslo, Oslo, Norway, (2)Diakonhjemmet Hospital, Oslo, Norway

Purpose: The overall aim of this study was to estimate total costs for patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in a cohort of patients treated with disease-modifying antirheumatic drugs (DMARDs). Specific aims were to compare costs across diagnoses and over time.

Method: The main data source was the Norwegian DMARD register (NOR-DMARD) that captures outcomes and resource use among patients starting therapy with synthetic and biologic DMARDs. Costs were estimated for four six-month periods from the start of a DMARD regimen. We included RA (n=1 664), AS (n=245) and PsA (n=491) patients with available 2-year data. Direct costs included pharmaceuticals, imaging examinations, stays in hospitals and rehabilitation units and visits to general practitioners, private rheumatologists, physiotherapists and outpatient clinics. Indirect cost included patients’ workforce participation. Differences in costs across diagnoses were tested by Kruskal-Wallis equality-of-populations rank test and changes in costs between first and fourth six-month period were tested by paired t-tests. 

Result: Total two-year costs were similar across diagnoses for patients on synthetic DMARD treatment (RA/AS/PsA $98 000/90 400/98 500) and on biologic DMARD treatment ($178 000/168 200/159 500). The largest cost component was productivity loss. Total costs decreased significantly from the first to the fourth 6-month period for all diagnoses, and this decrease was influenced by reductions both in direct and indirect costs. Mean total costs in US Dollar according to time period and diagnosis for patients treated with biologic DMARDs.
Diagnosis Type of DMARD Type of cost

Time period

p-value and 95%  CI for the change in cost between 1st and last 6-month period*

0-6 months

6-12 months

12-24 months divided by 2

RA Biologic n=489 Total

47 556

44 454

42 994

p<0.001 CI [2 964;3 974]
PsA Biologic n=124 Total

44 869

38 459

38 110

p<0.001 CI [3 198;9 691]
AS Biologic n=190 Total

46 320

41 613

40 111

p<0.001 CI [3 346;8 718]
*Paired T-test of no difference in costs between 1st and last 6-months period

Conclusion: Total costs were similar across the main inflammatory rheumatic diseases. Biologic DMARD treatment entails considerable drug cost but the total costs decline during the first two years on treatment in both RA, AS and PsA.